Active NPI
Kerin E Logstrom, MA, LMFT
- Marriage & Family Therapist
- Wayzata, MN
National Provider Identifier
1447543574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 2489
- Practice address
- 1001 Twelve Oaks Center Dr Ste 1030E
Wayzata, MN 55391-4320 - Phone
- (952) 457-5704
- Fax
- (612) 233-0045
- NPI assigned
- May 23, 2011
- Last updated
- Mar 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2489 | MN | Primary |
Addresses
Primary practice location
1001 Twelve Oaks Center Dr Ste 1030E
Wayzata, MN 55391-4320
Mailing address
506 Holly Cir
Wayzata, MN 55391-1369
Phone (952) 457-5704
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 18, 2024 through Jan 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1447543574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 HOLLY CIR",
"city": "WAYZATA",
"state": "MN",
"postal_code": "553911369",
"telephone_number": "952-457-5704",
"fax_number": "612-233-0045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 TWELVE OAKS CENTER DR STE 1030E",
"city": "WAYZATA",
"state": "MN",
"postal_code": "553914320",
"telephone_number": "952-457-5704",
"fax_number": "612-233-0045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGSTROM",
"first_name": "KERIN",
"middle_name": "E",
"credential": "MA, LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-23",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "2489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayzata, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.